2020 Winter Bulletin

Issue 2: Spring 2020

Table of Contents

Page 1 Help for Managing Your Care

Page 2 Coronavirus 2019 (COVID-19)

Renew Your Benefits Preventing and Reducing Fraud and

Abuse

Page 3 Summer Safety

Page 4 Teen Driver Safety

Page 5 Smoking: E-Cigs and Tobacco in Teens

Page 6 Making the Best of Your Doctor Visits

Three Ways to Help Your Baby Start Smart

Know What’s Covered

Page 7 Know Where to Go For After Hours -

Urgent or Emergency Care

Page 8 Visit Our Website

Helping You Get the Care You Need

Who to Call

Help for Managing Your Care Do you need help taking care of your health? Maybe you are living with several illnesses. Or maybe you have a long-term condition such as cancer, high blood pressure or diabetes. Care management may be able to help.

Care managers are nurses and social workers can: •

Help you understand your health problems• Help you learn how to take care of yourself.• Work with your doctors to get you the best care possible• Help schedule appointments• Help coordinate care• Connect you to services and resources in the community

(these could include food stamps or housing support)

You or your doctor may ask for care management. It is not required. Because it’s an opt-in program, you can choose to join or leave the program at any time without any impact to your benefits. Call Member Services at 1-800-953-8854 to find out more. You may also contact our Special Needs Coordinator at 1-443-713-4650 or fax to 1-844-284-7698.

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Coronavirus 2019 (COVID-19) MPC is dedicated to providing you and your families the most up-to-date information to protect you from COVID-19. COVID-19 testing when ordered by your doctor is covered at no cost to MPC members. Call your doctor with any concerns or symptoms and your doctor will tell you next steps. Your doctor’s phone number is listed on your MPC Member ID card and on the secure member portal. Visit our website at MarylandPhysiciansCare.com for resources and news related to COVID-19.

COVID-19 and Childhood Vaccinations During the COVID-19 pandemic, parents have kept their children home to keep them safe. At this time, many children have not received their recommended vaccinations to protect them from childhood diseases like measles, chickenpox, and others. It is very important to get your child back on track. Please view your child’s immunization records here and schedule an appointment with their doctor to bring them up to date on their vaccinations. Click here for a short video from the Maryland Department of Health for additional information.

Renew Your Benefits Did you know that to keep your health benefits, members must renew health coverage once per year? You can renew your health benefits in the following ways:

• Renew Online: Visit Maryland Health Connection’s website, create/log into your account, and click the “Change My Information/Renew Coverage” button.

• Renew by Phone: Call Maryland Health Connection at 855-642-8572 (TTY: 855-642-8573) to talk to an agent.

• Renew on the Mobile App: Use the “Enroll MHC” mobile app to re-enroll in Medicaid/MCHP, view notices, upload verification documents, and more.

• Renew in Person: Maryland Health Connection has an option to search for free, in-person help with renewal. Visit MarylandHealthConnection.gov for information.

Preventing and Reducing Fraud and Abuse Fraud and abuse occur when someone gives false information to receive health care benefits and/or services. Fraud and abuse are against the law. If you think a doctor, dentist, pharmacist at a drug store, or a person getting benefits is doing something wrong, you can report it. You don’t need to give us your name or contact information when you report it. But if you do, we’ll keep it confidential. You can also choose to give us just your contact information and not your name. Examples of fraud or abuse include:

• Getting paid for services that were not given or needed • Under-reporting resources and assets, such as bank account, stocks, bonds, home property • Falsely reporting household income • Not living in Maryland • Selling prescription medications

Please use the form on the Maryland Physicians Care website to report suspected fraud or abuse of services paid for by Maryland Physicians Care.

Summer Safety

Child Safety and Injury Prevention Injuries are the leading cause of death in children ages 19 and younger. But most child injuries can be prevented. Common preventable injuries are head injuries, driving injuries, and lead poisoning. Parents and caregivers can play a life-saving role in protecting children from injuries. Click here to learn about injury prevention topics.

Head Injury Prevention Keeping children and teens healthy and safe is always a top priority. Head injuries and concussions can happen when playing at the playground, riding a bicycle, or playing sports.

Brain Injury Basics It is important to learn how to recognize and respond to a concussion, especially if your child plays a contact sport. A concussion is caused by a hit to the head that makes the brain bounce around inside the skull. Click here for some videos to get pointers and real stories.

Playground Safety More than half of playground injuries are related to falls from playground gyms. These often result in broken bones and serious head injuries. Click here to learn more about playground safety.

Here’s some tips to keep your child safe: • Check that playgrounds have soft material under

them such as wood chips, sand, or mulch • Read playground signs and check that the

playground is right for your child’s age • Make sure there are guardrails in good condition

to help prevent falls • Look out for things in the play area that can trip

your child, like tree stumps or rocks

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Teen Driver Safety

Motor vehicle crashes are the leading cause of death for US teens. Each day, 6 teens aged 16-19 die due to motor vehicle crashes, and hundreds more are injured. Learn more on how to keep teen drivers safe here.

High Risk Groups • Male drivers ages 16-19 are in deadly crashes twice as

much as female drivers of the same age. • Teen drivers with teen passengers are more likely to be in

crashed. More teens in a car means more risk. • New Drivers are almost twice as likely to get in crashes.

Risk Factors • Inexperience – teens are not good at seeing risky or

dangerous things • Speeding – teens tend to drive faster, brake later, and

follow too closely • Use of Seat belts – almost half of young drivers who die in

car crashes were not wearing a seatbelt

• Alcohol Use – any amount of alcohol makes teen driving more risky

• Nighttime and Weekend Driving – 40% of teen driving crashes happen at night, 50% occur on Friday, Saturday, or Sunday

Prevention It is important to talk to your teen about the risks of driving. Parents are the key to reducing teen driving crashes. There are proven methods to help teens become safer drivers:

• Make teens aware of danger zones • Seat belts save lives • Not drinking and driving • Skill-building in new drivers • Learn more about tools for parents of new drivers here

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Smoking: E-Cigs and Tobacco in Teens

Use of Tobacco Smoking is bad for everybody, and it is even worse for teenagers. Substance use by teenagers can:

• Limit growth and development, especially brain development.

• Lead to other risky behaviors, unprotected sex, and reckless driving.

• Lead to health problems in adulthood like heart problems and high blood pressure.

Preventing tobacco product use with teens is critical to ending the tobacco epidemic in the U.S. Flavored tobacco products can make them appealing to young people. Find out more about youth tobacco prevention here.

Use of Electronic Cigarette (e-cigarette, or vaping) The use of e-cigarette is also driving tobacco product use in youth. Learn more about e-cigs here.

Key facts about use of e-cigarette or vaping products:

• Commonly called: vapes, e-hookahs, vape pens, tank, mods, and electronic nicotine delivery systems (ENDS)

• E-cigarette works by heating a liquid to produce an aerosol that users inhale

• Some e-cigarettes look like a regular cigarette, cigar or pipe

• Injuries from vape devices include: thermal or chemical burns, combustible injuries, acute and even chronic illnesses affecting the lungs

• The liquid can contain: nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils and other mind altering additives

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Making the Best of Your Doctor Visits How much do you think your doctor knows about your current health? Most likely a lot, but your doctor will know much more if you do your part to keep him or her informed. You and your doctor can make better decisions about your medical care by:

• Making sure your doctor knows of your visits to the emergency room or any unscheduled overnight hospital stays • Following up with your doctor after a visit with a specialist • Letting your doctor know your lab results • Letting your doctor know your numbers (blood pressure, cholesterol, hemoglobin A1c and body mass index) • Making sure your doctor is aware of any medication you are taking

To prepare for a visit with a new primary care provider (PCP), bring a list of all medications that you are taking. Include a list of any concerns or symptoms that you may be experiencing. No matter how big or how small, talking about your concerns with your doctor could make a big difference in your health. Be sure to maintain an open discussion with your new or current PCP so you can make better decisions about your care together.

Three Ways to Help Your Baby Start Smart There are things you can do to help your newborn get a healthy start.

1. See your doctor. Call your doctor if you think you are pregnant. You should have regular checkups throughout your pregnancy. Your doctor can check you for problems and make sure your baby is growing as expected.

2. Have healthy habits. Eat nutritious foods and get plenty of rest and exercise. Also be sure to stay away from tobacco, drugs and alcohol.

3. Sign up for Start Smart for Your Baby®. This is a Maryland Physicians Care program for women who are pregnant or who just gave birth. Call us for more information.

Know What’s Covered Maryland Physicians Care wants you to get the care you need, when you need it. We make decisions about the care to cover based on:

•

If the service is needed • If the service works well • If the service is right for you

Additionally:

• We do not make choices about care based on how much it costs. • We also do not reward doctors or staff for saying no to care. • Utilization Management decision-making is based only on the appropriateness of care and the service being provided. • Maryland Physicians Care does not reward health care providers or other individuals for issuing denials of coverage or

service. • There are no financial incentives for UM decision makers to encourage underutilization.

If you have a question about whether a medical service is covered, our Utilization Management (UM) Department can help you. UM may look at your records and talk with your doctor. Call us at 1-800-953-8854.

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Know Where to Go for After-Hours, Urgent or Emergency Room Care

It is important to choose the right place for care at the right time. Below is a guide to help choose the right place based on your health needs.

Doctor’s Office Urgent Care Center

Emergency Room

Checkup Minor illness/injury Unconsciousness

Health screening Flu/fever Difficulty breathing

If something causes you concern

Vomiting/diarrhea Serious head, neck, or back injury

Cough/cold Sore throat, earache, or eye infection

Chest pain/ pressure

Fever Sprain/strain Severe bleeding

Lingering pain Possible broken bone

Poisoning

Unexplained weight loss

Sports Injury Severe burn

Convulsion/ seizure

Severely broken bone

Sexual assault

After Hours If you need nonemergency care after normal business hours, you can use the free MyVirtualMPC mobile app for a quick video visit with a local doctor. Visit www.myvirtualmpc.com for information and to register or download the app from your smartphone’s app store. You can also call your PCP’s office or the 24-hour Nurse Advice Line. Both numbers are on your Maryland Physicians Care member ID card. Your doctor or the answering service will be able to answer

your questions or guide you to the right place to get care.

Urgent care If you have an illness or injury that could turn into an emergency within 48 hours if it is not treated, go to an in-network urgent care center. Preauthorization is not required, but the center must participate with Maryland Physicians Care or you may be billed. If you are unsure if you should go to an urgent care center, use the MyVirtualMPC mobile app to talk to a doctor between 9 am and 9 pm right from your phone.

Emergency room care What’s an emergency medical condition? It’s one that requires immediate medical attention to avoid serious impairment to your health. If you need emergency care, call 911 or go to the closest hospital emergency department. You can self-refer to any emergency department. Preauthorization is not required. If your PCP and MCO are unaware of your emergency room visit, call them afterward so they can arrange for any follow-up care you may need. If you are unsure if you should go to an urgent care center or the emergency room, call your PCP or the MCO 24-hour Nurse Advice Line. Both numbers are on your MCO card.

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Helping You Get the Care You Need Everyone has unique health needs. We get that. So, no matter what your health needs are, we are here for you when you need us.

For more information about Utilization Management, please call 1- 800­953-8854, then follow the prompts. Staff is available at least eight (8) hours a day during normal business hours for inbound collect or toll-free calls regarding utilization management issues. Staff can receive inbound communication regarding UM issues after normal business hours by fax to 1-877-535-0591 or phone 1-800-953-8854 and following prompts to the UM department and leaving a voice message. Communications received after normal business hours are returned the next business day. Communications after midnight M-F are returned the same business day. Maryland Physicians Care TDD/TTY (Telecommunications Device for the Deaf/TeleTypewriter) services are provided for members who need this service at 1-800-735-2258. Language assistance is also available, free of charge, for members to discuss utilization management issues. MPC requires utilization management staff to identify themselves by name, title and organization when initiating or returning calls regarding UM issues.

Some health care services and medications may require Prior Authorization (PA). This is when your provider is requesting a service or drug that requires us to give our approval before you can get the services. Your provider is responsible for getting the PA and cannot bill you when they fail to do so.

Visit our website Find information on: • Quality improvement program • Case management program • Disease management program • Clinical practice guidelines • Utilization management, including decision-making criteria, affirmative statement and staff availability

• Pharmacy and prescription drug management

• Benefits and coverage • Member rights and responsibilities • Protected health information use and

disclosure • Member handbook • Provider directory

If you do not have internet service, you can reach us by phone (numbers listed in “Who to call”) for more information.

Who to call Member Services (benefits, ID cards, appeals, PCP changes, etc.): 1-800-953-8854

DentaQuest (adults only): 1-800-685-1150

Healthy Smiles Dental Services: 1-855-934-9812

Public Mental Health Services: 1-800-888-1965

Superior Vision: 1-800-428-8789

Utilization Management (UM): 1-800-953-8854 — follow prompts to UM

Case Management/ Disease Management: 1-800-953-8854

Health Education Requests: 1-800-953-8854

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Nondiscrimination Notice

Maryland Physicians Care complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Maryland Physicians Care does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

Maryland Physicians Care:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters o Written information in other formats, such as large print in a manner that takes

into consideration the special needs of those who are visually impaired, hearing-impaired or have limited reading proficiency

• Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages

If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card or 1-800-953-8854.

If you believe that Maryland Physicians Care has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with our Civil Rights Coordinator at:

Address: Attn: Civil Rights Coordinator 1201 Winterson Road Linthicum, MD 21090

Telephone: 1-800-953-8854, TTY 1-800-735-2258

Email: MPCCompliance@marylandphysicianscare.com

You can file a grievance in person or by mail or email. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.